Can Blepharoplasty Qualify as a Medically Necessary Procedure?

The eyelids are one of the first areas to show signs of aging. And while most people opt for blepharoplasty (eyelid surgery) for cosmetic reasons, this procedure is done to improve function and comfort.

So, when is blepharoplasty no longer considered an elective cosmetic procedure but a medically necessary intervention? We asked our expert, Dr. Scott Beeve, to explain the difference between the two.

Understanding what a blepharoplasty is

A blepharoplasty is a surgical procedure designed to repair drooping eyelids by removing excess skin, muscle, and sometimes fat from the upper or lower lids. We can perform the surgery on the upper eyelids, the lower eyelids, or both.

Why tissue around the eye drops

There are many reasons for droopy eyelids, the most common one being aging. The skin around the eye is thin and more susceptible to gravity as it loses elastin and collagen, causing it to wrinkle and droop.

Aside from aging, certain conditions such as Horner’s syndrome, nerve communication issues around the eyes, strokes, and even tumors can cause cosmetic changes.

When is a blepharoplasty primarily cosmetic?

Blepharoplasty is cosmetic when the primary goal is to improve appearance without addressing any functional impairment, which is often the case when a patient seeks to smooth out wrinkles and fine lines, remove puffy bags beneath the eyes, and achieve a more defined upper eyelid crease.

In these cases, the procedure is elective and typically paid for entirely by the patient, as insurance does not cover purely aesthetic enhancements.

When does blepharoplasty qualify as medically necessary?

The procedure qualifies as medically necessary and may be covered by insurance when excess skin and fat significantly impair the patient’s ability to see.

This issue occurs when the upper eyelids fall low enough over the pupil, blocking part of the visual field. To determine if you qualify for this type of procedure, visual field testing is typically used to demonstrate that excess eyelid tissue is causing a functional impairment.

In addition to vision obstruction, chronic irritation — where skin folds rub repeatedly against the eyelashes — can also be a reason for a medically necessary blepharoplasty.

Learn more about who can benefit from a blepharoplasty

The benefits of blepharoplasty go beyond appearance alone. For many patients, the procedure restores the visual field, reduces eye strain caused by constant squinting, and makes eyelid hygiene easier, as excess skin folds no longer collect moisture and bacteria.

If you have heavy or droopy eyelids and are unsure whether they qualify as medically necessary, contact us to schedule an appointment today at our office in Glendale, California. After an examination, Dr. Beeve discusses whether you are a candidate for blepharoplasty as an elective cosmetic surgery or as a medically necessary procedure.